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Government Audits and Investigations: Financial Risk Areas and Building a Proactive Response Team
Date
October 25, 2019
Due to their participation in multiple federal health care programs (such as Section 330 of the Public Health Service Act, Medicaid, and Medicare), health centers are subject to scrutiny from a number of different sources: HRSA’s Division of Financial Integrity, Medicare Administrative Contractors (MACs), CMS’s Unified Program Integrity Contractors (UPIC), State Medicaid Fraud Control Units (MFCUs), and the Office of Inspector General (OIG), just to name a few. Fortunately, there are a number of proactive steps a health center can take to minimize the potential of an audit or investigation taking place or for reducing their scope or duration.
This session will address those proactive steps such as establishing an “advance team,” reviewing billing policies and procedures, identifying common risk areas, and conducting self audits. Health centers also need to know how to respond in the event that they receive a notice of an audit or investigation. When a health center has been armed in advance with the knowledge of who should be involved in responding to an audit or investigation, the health center can do a better job of responding in an organized and thoughtful fashion.
CMS, State Medicaid programs and commercial payers are getting more aggressive in moving providers from volume to value-based pay (VBP). Exactly how VBP will be implemented is evolving, particularly for FQHCs, but it does appear to be here to stay…
While working to respond to the COVID pandemic, health centers received a tremendous amount of support. This support came in the form of grant funds, provider relief payments, the payroll protection and EIDL loan programs, and other resources…
Community health centers received an influx of funding from several federal stimulus sources in response to COVID-19 via CARES Act and American Rescue Plan Act Funding…
1. Discussion of overall implications of pharmacy issues 2. Impact of manufacturers on CHCs and the risk to the CHC program as a whole 3. Strategy for moving forward 4. Split billing and compliance strategy 5. Legislative updates 6…
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